The Medical Training (Prioritisation) Act 2026 received Royal Assent on 5 March 2026. If you qualified outside the UK, Ireland or the EFTA states, it changes where you stand when you apply for NHS training posts. It changes less than most of the coverage suggested, and it leaves several things alone that people assume it touched.
This page sets out what the law actually says, what the GMC’s exam changes mean in practice, what the realistic routes look like from here, and how doctors are funding the years those routes take.
We’re not a law firm and this isn’t immigration advice. Every claim below links to the body that issued it, so you can check it yourself before you make a decision.
What the Act actually does
The Medical Training (Prioritisation) Act 2026 requires decision-makers to prioritise certain applicants for UK medical training. It works in three stages.
For the Foundation Programme, UK medical graduates and the priority group are offered places before other eligible applicants, applied at allocation to foundation school.
For specialty training starting in 2026, prioritisation applies at the offer stage only. NHS England’s guidance explains why: shortlisting was already under way when the Act passed.
For 2027 onwards, it applies at both shortlisting and offer.
The priority group is defined in section 4. It covers medical graduates who trained in Ireland, and holders of primary qualifications from Iceland, Liechtenstein, Norway or Switzerland. Separately, certain immigration statuses carry prioritisation for specialty training: British citizens, Commonwealth citizens with right of abode, Irish citizens, people with indefinite leave, and those granted residence scheme immigration status.
What the Act does not do
This is the part worth reading twice, because it is where most of the anxiety is misplaced.
You are not barred from applying. If you are not in a priority group you can still apply to UK specialty training, and you can still be appointed. You are ranked after the prioritised groups for the posts you compete for.
It does not touch the jobs most international doctors in the UK are already doing. NHS England is explicit that the changes do not affect locally employed doctor posts, SAS roles or consultant posts. If you are working in the NHS outside a training programme, your position is unchanged.
Public health medicine is excluded from prioritisation altogether, because that specialty accepts medical and non-medical applicants.
And section 3 leaves a door open. It allows regulations to extend prioritisation to doctors with significant experience of working as a doctor in the NHS or Health and Social Care. The definition is being developed through 2026 and 2027. If you are already working here, that is the provision to watch.
Why the PLAB exam centres are closing
From February 2027 the GMC is closing international PLAB 1 test centres in Dhaka, Alexandria, Accra and Chennai, and reducing sittings outside the UK and EEA from four a year to three.
The reason matters more than the fact. The GMC’s own statement gives it plainly: bookings fell 40% between 2023 and 2025, and there is no longer sufficient demand to keep those centres running.
So this is not a door being closed on you. It is a measurement of how many doctors already decided to go elsewhere. If you are weighing up the UK against another country, you are not early to that question.
The routes, and what each one really costs you
Every route below is a real option in 2026. None of them is quick.
Stay with the UK. PLAB, then GMC registration, then apply without prioritisation, or take a locally employed or SAS post and build the NHS experience that section 3 may come to recognise. Check current requirements with the GMC.
United States. USMLE Steps, ECFMG certification, then the Match. It has the largest number of training posts of any option here, and the most moving parts. One of them is moving right now: a federal court struck down the $100,000 H-1B entry fee in June 2026, but the fee continued to apply pending appeal. Do not plan your finances on where that lands. Check the current position with ECFMG and take immigration advice from someone qualified to give it.
Ireland. The Pre-Registration Examination System, run by the Medical Council. Worth noting that Irish graduates are inside the UK priority group, which does not work in reverse for entry to Irish training.
Australia. The Australian Medical Council examinations, or the Competent Authority Pathway if your qualifications and experience qualify you for it. A PLAB pass can support a Competent Authority application, which is the one place where UK exam work carries over cleanly.
New Zealand. NZREX Clinical, through the Medical Council of New Zealand.
Canada. MCCQE and the NAC examination, then CaRMS. Be realistic here. The number of residency posts open to international graduates is small relative to the number of applicants, and most provinces attach a return-of-service commitment.
The Gulf. Licensing through the relevant emirate or national authority, such as DHA, MOH or QCHP. Faster to enter than the routes above, and it does not lead to a UK, US, Canadian or Australian training certificate.
What all of these have in common
Exams cost money. Applications cost money. Relocation costs money. And the gap between deciding and starting is usually measured in years, not months, during which you still need an income and you would rather not lose the clinical reasoning you spent a decade building.
That gap is the actual problem most doctors write to us about. Not which route is best. How to survive the middle of one.
Funding the years in between
One option is remote AI training work: reviewing and correcting what medical AI models produce, and being paid for the judgement rather than the shift.
Be clear about what it is. It’s freelance, it’s project-based, and it’s not a career. It won’t count towards training, it won’t appear on a CV as clinical experience, and it isn’t a substitute for a post. What it does is pay in USD, run on your hours rather than a rota, and use exactly the reasoning your exams are testing.
Applied Clinical Judgement is a UK-based referral intermediary. We point you to genuine openings on the major training platforms and are paid only when a referral succeeds. Pay rates are shown on each role.
If that sounds like it might bridge your gap, start with the roles open to your country and work back from there.
Common questions
Does the Act stop me applying to UK specialty training?
No. You can apply and you can be appointed. You are ranked after the prioritised groups, at the offer stage for 2026 starts and at both shortlisting and offer from 2027.
I’m already working in the NHS as a locally employed doctor. Am I affected?
Not in that post. NHS England states the changes do not affect locally employed doctor posts, SAS roles or consultant posts. Section 3 also allows future regulations to prioritise doctors with significant NHS experience, so this is the provision to follow.
Should I still sit PLAB if the centres are closing?
Four centres close in February 2027 and sittings outside the UK and EEA drop from four a year to three. The exam continues. If PLAB is on your path, the change is about where and how often you can sit it, so book earlier than you would have.
Which route is fastest?
Gulf licensing is generally quickest to enter and does not produce a UK, US, Canadian or Australian training certificate. Everything else is measured in years. Choose on where you want to practise in ten years, not on which exam you can book soonest.
Can AI training work count towards my training or registration?
No. It’s freelance work that pays while you study. Treat it as income, not experience.
Sources: Medical Training (Prioritisation) Act 2026 · NHS England applicant guidance · GMC, changes to international exam locations. Immigration and licensing rules change. Check the issuing body before you act on anything here.